Smoke
under fireCritics
say the bureaucracy is so taxing for the sick that
medicinal marijuana is hardly worth it

October
6, 2003
Karen Gram, Vancouver Sun

Phillipe
Lucas is legally entitled to possess marijuana to cope with Hepatitis
C, but getting it legally is about as tough as getting a drink
from a prohibitionist.

If
you have chronic back pain, are undergoing chemotherapy or dealing
with another medical condition and want to see if "medicinal
marijuana" might help, bringing the option up with your
family doctor might seem a little awkward. Actually getting the
stuff, it turns out, is even harder.

"The
Office of Cannabis Medical Access is the biggest oxymoron there
is," Lucas says. "It's not about access, it's all about
denying or complicating access."

According
to Lucas, one third of the members on the advisory committee
to the OCMA represent organizations opposed to marijuana access,
organizations like the RCMP, Canadian Chiefs of Police, Physicians
for a Smoke Free Canada and the Canadian Medical Association.
Only two members are medicinal marijuana users. The bureaucracy
they have set up is so onerous for sick or disabled people,
it's hardly worth it, he says.

Following
the steps Lucas took to get access demonstrates the thicket that
keeps patients from easy access -- medicinal marijuana may be
technically legal, but it's far from an easy prescription to
obtain.

Like
all others applying to get medicinal marijuana provided by the
government, Lucas had to first be authorized to possess it. That
required a lengthy bureaucratic procedure which he will have
to repeat every year, even though his condition won't have changed.

Hepatitis
C is considered a category-three disease by the OCMA, neither
terminal (category one), nor one of the specified diseases
(category two), so Lucas had to get two specialists to fill
out a very detailed application stipulating that the benefits
of marijuana outweighed any risks and recommending a cannabis
dosage. Few physicians are willing to do that, especially when
the CMA and the colleges that licence doctors have both urged
them not to.

"We
are opposed to physicians distributing medical marijuana and
in the vast majority of cases we are also opposed to physicians
prescribing it," said BC Medical Association president-elect
Dr. Jack Burak in an interview.

Burak
said distributing marijuana poses safety issues such as break-ins
and violence for doctors while prescriptions should not be
written for medicines in which the doctor can not be sure of
the bio-availability or concentration of drug.

"The
prudent move would be to hold off until we have scientifically-based
knowledge that this is efficacious and therapeutic," he
said.

Lucas
was already using marijuana he purchased from the Vancouver Island
Compassion Club, which he runs. But he wanted to be part of the
legal system, under which his use of marijuana would be recognized
as medicinal. Following the paperwork, he was able to convince
two specialists to sign on, though he knows of other patients
that have had a harder time accomplishing this task. He was also
required to submit two passport photos signed by his doctor verifying
his identity.

As
of August, 642 Canadians, 108 of them in B.C. including Lucas,
had been granted authorization to possess. (Compassion Clubs,
whose organic medicinal marijuana sales to sick and disabled
Canadians are generally tolerated by police, serve eight times
that number across Canada nearly 5,000, 3,000 of whom live
in B.C.).

Medicinal
marijuana is still on the fringes of medical therapies but it's
been gaining a great deal of attention throughout the world as
ill people report how it relieves their pain and symptoms, enhances
their appetite or helps them sleep.

In
Canada, Former Health minister Allan Rock spearheaded legislation
permitting some ill Canadians to possess pot during the first
years of the new millennium. Access and distribution was another
story. Rock was replaced as health minister by Anne McLellan
in January 2002 and she is not nearly as comfortable with medicinal
marijuana as her predecessor.

"I
feel a certain degree of discomfort around this issue," she
told doctors at the annual meeting of the the Canadian Medical
Association. McLellan wanted the clinical proof that marijuana
helps without harming before she distributed it.

By
the time she made those comments in August 2002, medicinal users
were already frustrated. Months before she spoke to the doctors,
in May, users had initiated court proceedings. What good does
it do to be permitted legal possession without legal access?
they argued.

In
February 2003 Ontario Court Justice Lederman agreed, saying
Health Canada Medical Marijuana Access Regulations (MMAR) were
unconstitutional and therefore invalid, and that they only
provided the "illusion of supply." Judge Lederman
gave Health Canada six months to rectify the situation ordering
the Health ministry to ensure medicinal users had access to
marijuana within that time.

With
the deadline just days away last July, McLellan announced the
ministry would distribute the marijuana it had been growing in
a Flin Flon, Man., mine shaft through the patients' physicians.
The doctors balked, so did their medical associations and colleges
sending out letters saying they disapprove of doctors distributing
or prescribing.

The
hush around the subject is such that none of the doctors contacted
for this article would talk on the record about prescribing or
distributing marijuana.

Lucas
got his doctor to fill out a detailed application, then swore
before a lawyer that he wouldn't use any other cannabis while
using the government's supply. He applied for seeds and cannabis,
but the government notified him he had to choose one or the other.

In
the end he chose the cannabis and his doctor completed the form
saying he should have it. Lucas says his doctor (whom he wouldn't
name for fear he'll be reprimanded by the Canadian Medical Association),
didn't want to receive the cannabis at his office so they created
a lengthy paper trail, arranging for it to be sent to the Vancouver
Island Compassion Club. Including phone calls, the procedure
required four or five consultations with the doctor."To
think that someone critically ill would have to go through this," he
said. "I think this whole program was set up to fail."

That's
what Hilary Black of the B.C. Compassion Club thinks too. "The
whole thing has been a bit of a saga," she says. "A
bit of progress, then some back pedaling and then sabotage."

In
the process of putting the court-ordered program in place, the
government has alienated the doctors, ignored the expertise offered
by the compassion clubs and frustrated patients, says Black.

To
top it off, approved users can't rely on the supply because
McLellan says she will immediately stop the program if the
government wins a court appeal. "Health Canada is doing
what is necessary to appear to be fulfilling the program demands
while setting up a program destined to fail," says Black.

If
the government really wanted sick Canadians to be able to relieve
their suffering with marijuana, they would give doctors the power
to prescribe it and have the compassion clubs which have years
of experience, distribute it, says Black.

Instead,
it has unduly stressed the very people it is supposed to be helping,
she says, adding compassion clubs handle the whole thing much
more "compassionately." She argues that patients shouldn't
have to go through a completely different process for medicinal
marijuana than they would for any other medicine."

George
Bailey, 50, has been getting his medicine from the B.C. Compassion
Club for six years, ever since an inflammatory bowel disease
and six surgeries collapsed his immune system and left him
with chronic pain, nausea and occasional seizures. Compared
to Lucas, Bailey, a former psychiatric nurse, felt positively
supported in his marijuana use.

When
he decided to try cannabis, The Compassion Club gave him a package
of information including a one-page application requesting his
doctor to spell out Bailey's medical diagnosis.

Because
of security issues, the Compassion Club won't give clients the
names of doctors who have signed forms in the past. It just recommends
clients keep trying if their first doctor refuses.

On
the form, the club asks if the doctor recommends pot for the
patient's symptoms. If not, why not? (The club staff will still
sell marijuana to a person with a verified medical condition
if the doctor doesn't recommend it, as long as the reason is
not medical.) Then the doctor has to stamp it, sign it and fax
it to the Compassion Club. The club staff then phone to confirm
the veracity of the form and put the patient on a waitlist for
an orientation.

Currently,
the waitlist is two months long. The club already serves 2,700
members and is having space problems. However, it is having
trouble getting city approval to expand into the empty space
at offices of B.C. Person's with AIDS. Black surmises the problem
may have to do with the illegality of its operation. The club
has been unofficially tolerated by the police ever since the
Victoria club was raided, taken to court and given a conditional
discharge and a commendation for providing a needed service.

Once
Bailey's signed form arrived, he had an orientation in which
club staff taught him safe and effective use of cannabis. He
learned that the effects of Indica strains are physical, good
for pain relief and relaxation or insomnia while Sativa strains
work on the mind, to relieve depression and head-aches, increase
energy, stimulate the appetite and increase creativity.

The
club sells nine or 10 strains, some of which are organic, some
grown indoor, some outdoor, some pure strain and some crosses.

He
learned that smoking the marijuana brings relief in 30 to 60
seconds while eating it or using a tincture can take one-two
hours making it more difficult to know how much to take. He
was advised to take a few puffs and wait 15 minutes before
deciding if he needs more.

He
was advised not to operate heavy machinery while impaired by
cannabis especially Indica strains which can be sedating. Mixing
it with alcohol could cause vomiting.

Lucas
got none of this guidance from Health Canada, though some of
it can be found through a link on Health Canada's Web site. He
just had to sign a form saying he is aware that marijuana has
not been tested for the Food and Drug Act for safety or effectiveness.

When
Bailey needs marijuana, he goes to the club on Commercial Drive,
shows his membership card to the receptionist, gets a number
and is ushered into the waiting room where the nine or 10 strains
available that day are posted with their price per gram.

Bailey
uses 11/2 grams a day of a pure Indica strain called Legends
Ultimate Indica which promises good pain relief and sleep. It
costs $9 per gram. Often, he says he will ask the staff for advice
on a good strain for his complaints. And since resistance to
a particular strain can develop, their advice is valuable. He
says he usually buys enough for a week, but on this day, he can
only afford two grams.

It
can be tough to find the money for it on a disability pension,
and marijuana is not covered by the B.C. Medical Plan nor any
extended health plans, but the relief is worth the expense
to Bailey.

When
he pays, his particular purchase is recorded in the computer
so that staff can go back and see his record of purchases and
make knowledgeable recommendations.

Bailey
didn't apply for government authorization to possess nor to receive
government pot because he believes the process is discriminatory.
No other prescription holder is treated this way, he says.

"I
feel like I can come here, access quality medicine and quality
wellness therapies from the club's wellness centre and not be
hassled. . . . For me, it comes down to trust. I trust this facility."

Black
says the government is willfully ignoring the compassion clubs
expertise despite her best efforts to offer it. She has spoken
to the advisory committee and Health Canada representatives
several times and given them documents with reams of information.

She
says she believes experts need to be consulted on such topics
as where to get good product, the value of organics, the dangers
of contamination and other issues and argues that Prairie Plant
Systems, which won the government growing contract, had no experience
with pot. PPS, she says, grow the pot non-organically, despite
the purity n